Drug Harm Reduction: List of What You Should Know

Drug harm reduction for people who are going to use drugs.

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Each year, millions of people use both illegal and legal drugs.

If you use drugs, or are likely to use drugs in the future, please read this.

definition: drug


  1. “a medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body.”

General guidelines for all substances

  1. Test your drugs where relevant, as adulterants are common in many drugs. “My guy gets pure stuff” is a very popular but dangerous belief. A dealer knowing their stuff doesn’t tell you anything about their supply chain.

  2. Start low (dosage), go slow

  3. Have at least one friend who serves as a sober sitter, especially for first experiences with any drug

  4. Be aware of the laws where you live. Unfortunately, in many cases, the harms of criminalization of drug users substantially exceeds the harms from the drug use itself.

  5. Spend ~2+ hours researching any drug you’re considering using (reading trip reports doesn’t count) before taking it for the first time

  6. Most US states, though sadly, not all, give you immunity when the ambulance/police arrive from drug possession if you call 911 for someone who needs help. See a map of state laws here. Call an ambulance if someone needs help.

  7. Try and avoid using drugs to deal with anger or sadness.

1. Drugs - nicotine, alcohol and opioids in particular - kill thousands of people each year

Overdose Deaths

Drugs Involved in U.S. Overdose Deaths. Source: CDC

Top 5 drugs by number of deaths per year in the US:

  1. 480,000 deaths per year: nicotine in the form of cigarettes1
  2. 88,000 deaths per year: alcohol2
  3. 60,000 deaths per year: opioids including fentanyl, heroin, codeine, hydrocodone (Vicodin), oxycodone (Oxycontin), methadone3 4
  4. 10,500 deaths per year: cocaine4
  5. 7,500 deaths per year: methamphetamine4

These numbers are of course biased, because more people use alcohol than use methamphetamine.5

2. Addiction and dependence rates vary wildly depending on the kind of drug

Drug Proportion of people who used outside of medical settings that become dependent6
Tobacco 32-68%
Alcohol 15-23%
Heroin 23%
Cocaine 17-21%
Stimulants 11%
Anxiolytics (includes benzodiazepines) 9%
Analgesics i.e. pain relievers 8%
Cannabis 9%
Psychedelics 5%

This surprised me when I read it, too. I was expecting to see that 50%+ of heroin users would become dependent, but, that isn’t the case.

3. Before you use any substance, you should research two things

  1. How safe or dangerous is it? How does it compare to other drugs? What are the downsides? What are the upsides?

  2. If you choose to use it, how can you do so in a way that minimizes potential harms to yourself or others, and maximizes potential benefits?

As a good approximate rule of thumb, plan on doing at least 2 hours of thorough research (reading trip reports does not count) into any substance you’re considering trying, before using it. Avoid ever using substances on a whim without research beforehand if e.g. offered at a party.

Part of researching safe use will involve researching which drug combinations are dangerous.

Comparing upsides of substances

Upsides and downsides of various substances

From this we can see that caffeine has a upside-downside curve that is weighted much more to the positive, in contrast to Facebook and tobacco which are weighted much more to the negative.

Note: E-cigarettes were not surveyed separately. Their upside-downside profile would likely be different compared to tobacco/cigarettes more generally.

Drugs kill thousands of people each year - we do not endorse the use and acquisition of drugs, legal or illegal. If you make the choice to use any substances, including alcohol, please do your research.

Substance % Worse without Respondents that had tried Number worse without7
The internet 83.4% 862 719
Psychedelics in general 80.1% 819 656
Smartphones 73.4% 848 622
YouTube 72.0% 832 599
LSD 71.9% 1023 735
MDMA (100% MDMA or high MDMA content) 67.8% 723 490
Smoked cannabis 65.7% 1316 865
Magic mushrooms 64.6% 845 546
Caffeine 63.1% 1298 819
Reddit 61.6% 856 527
Vaporized cannabis 59.1% 975 576
Television (including Netflix) 56.0% 811 454
Edible cannabis 53.2% 1074 571
Amphetamine (incl Adderall) 51.3% 874 448
DMT (N,N-DMT, the one with entities) 48.2% 432 208
MDMA (Ecstasy, purity/contents unknown) 47.9% 774 371
Porn 45.7% 851 389
Stimulants in general 44.8% 669 300
Ketamine 42.6% 516 220
Alcohol 42.6% 1297 552
Sugar (including in food) 41.9% 821 344
Kratom 36.4% 516 188
2C-B 36.2% 473 171
Benzodiazepines (Xanax, etc) 35.1% 816 286
Nitrous oxide 30.8% 591 182
Codeine 29.1% 553 161
Opioids in general 25.3% 498 126
Peyote (mescaline) 24.8% 298 74
Oxycodone 23.7% 510 121
Hydrocodone 23.7% 532 126
Tobacco (nicotine) 22.6% 1123 254
Twitter 21.7% 635 138
Cocaine (snorted) 19.9% 693 138
5-MeO-DMT (contained in one psychoactive toad and some plants) 19.0% 274 52
Facebook 15.5% 768 119
Salvia 14.3% 427 61
Methamphetamine (incl Desoxyn) 13.4% 344 46
Other 2C-x (2C-I, etc) 13.0% 324 42
Heroin 10.3% 331 34
Crack (smoked) 4.3% 301 13
Synthetic cannabis (Spice, K2, etc) 3.9% 539 21

View these results as images instead: https://imgur.com/a/ElbJh.

Comparing downsides of substances

Substance % Better without Respondents that had tried Number better without7
Synthetic cannabis (Spice, K2, etc) 59.2% 539 319
Facebook 55.0% 768 422
Tobacco (nicotine) 49.9% 1123 560
Heroin 43.5% 331 144
Alcohol 35.4% 1297 459
Methamphetamine (incl Desoxyn) 33.7% 344 116
Crack (smoked) 33.6% 301 101
Sugar (including in food) 33.3% 821 273
Benzodiazepines (Xanax, etc) 32.2% 816 263
Oxycodone 32.0% 510 163
Opioids in general 31.7% 498 158
Hydrocodone 29.9% 532 159
Cocaine (snorted) 28.7% 693 199
Porn 28.3% 851 241
Twitter 25.8% 635 164
Codeine 23.2% 553 128
Stimulants in general 19.1% 669 128
Television (including Netflix) 18.7% 811 152
Reddit 18.7% 856 160
Salvia 18.5% 427 79
Amphetamine (incl Adderall) 17.7% 874 155
MDMA (Ecstasy, purity/contents unknown) 17.4% 774 135
Smoked cannabis 17.1% 1316 225
Smartphones 14.5% 848 123
YouTube 12.6% 832 105
Nitrous oxide 12.4% 591 73
Vaporized cannabis 10.3% 975 100
Other 2C-x (2C-I, etc) 9.9% 324 32
Caffeine 9.9% 1298 128
The internet 9.5% 862 82
Edible cannabis 9.5% 1074 102
Ketamine 7.6% 516 39
MDMA (100% MDMA or high MDMA content) 7.5% 723 54
Kratom 6.8% 516 35
5-MeO-DMT (contained in one psychoactive toad and some plants) 6.6% 274 18
LSD 5.2% 1023 53
2C-B 5.1% 473 24
Psychedelics in general 3.3% 819 27
Peyote (mescaline) 3.0% 298 9
DMT (N,N-DMT, the one with entities) 3.0% 432 13
Magic mushrooms 2.6% 845 22

“These people must be lying to themselves - only 56.5% (100% - 43.5%) of people don’t think they’d be better off without heroin”, you say? Remember, around 77% of people who use heroin outside of a medical setting *do not* become dependent, so it makes sense why 56.5% of people who had used heroin in a survey wouldn’t be particularly concerned about it, because based on the research 77% of those who had tried it in non-medical settings wouldn’t have become dependent.

Comparing safety of substances

A paper by David Nutt compares the harms of drugs.8

Relative side effects of drugs

The blue bars (harm to users) are independent of the popularity of the drug, while the red bars (harm to society) are dependent on the popularity of the drug. Even if the same number of people used MDMA as use alcohol, their blue bars/harm to users scores would still be the same.9

“Finally, we should note that a low score in our assessment does not mean the drug is not harmful, since all drugs can be harmful under specific circumstances.”8

4. Sugar is considered a drug under some definitions

My understanding is that sugar has a physiological effect,10 and so then at least using the definition of ‘drug’ provided by Google, sugar would be considered a drug.

I used to believe that fat people were lazy, and I was a strong advocate for the ‘calories in, calories out’ model, where all you need to do to lose weight is to eat fewer calories than you burn.

I now believe it’s not so simple. The things that changed my mind were:

  1. This podcast episode by Robert Lustig, thanks to a friend for showing me it.

  2. This video about the microbiome by Kurzgesagt.

  3. This summary of work by Gary Taubes.

Sugar dependence seems to be very real. I’ve talked with someone who struggled from sugar dependence, and their sugar dependence seemed to cause them immense pain and heartache, and they had extreme difficulty finding effective treatments.

5. Safety information to read first if you’re likely to use specific substances

Opioids, benzos, crack, meth, alcohol, tobacco, or spice

Think about re-considering. These are the substances which the highest percentage of people who believe their life would be better if those substances didn’t exist.

Also, tobacco seems to have the highest rate of dependence of all drugs, with 32-68% of people who use tobacco once ending up dependent on it. Even heroin is substantially lower, with 23% of people who use heroin at least once outside of a medical setting becoming dependent.6

For people who have used alcohol or nicotine (cigarettes) in the past 12 months, it’s even worse - 50% (!) of people who used alcohol in the last 12 months in this study were clinically defined as alcohol dependent, and 80% of people who used nicotine in the last 12 months were defined as nicotine dependent.11


Watch this: The Drug Classroom.

Readings: One, two, three, four, five, and finally six (more thorough). Information for friends of opioid users: one.


Readings: crack harm reduction.





Watch: Alcohol - The Drug Classroom

Read: alcohol harm reduction, this, and another guide.


Watch: Meth - The Drug Classroom


Watch: this video

Read: this, this awesome guide, this and this


Watch: Tobacco - The Drug Classroom


Read: this PDF about Spice/K2 harm reduction.

Other stimulants such as Adderall, Vyvanse, Ritalin, Amphetamine

Watch: Adderall - The Drug Classroom

Read: This guide, this, AddySafe, this and this


Watch: Caffeine - The Drug Classroom.



Watch: MDMA - The Drug Classroom.

Read: How to Take MDMA - RollSafe.

LSD, Shrooms, other Psychedelics

Watch: Psilocybin (Mushrooms) - The Drug Classroom.

Read: How to take LSD and how to take Shrooms, and this guide on LSD


Watch: Ketamine - The Drug Classroom.

Read: Ketamine - DrugScience and this great set of ketamine harm reduction strategies, and this guide, and this


Read: Salvia - TripSafe and Salvia - DrugScience. This list of supplements for reducing anxiety is meant for classic psychedelics but should apply to salvia also.


Listen to this podcast episode by Robert Lustig.

Limit intake to 10% of calories - on average, this would mean less than 50g total sugar per day for women, and less than 63g total sugar per day for men.

Facebook, Twitter

Read this article about app addiction.

If you need help, try:

  1. Intent

  2. RescueTime

  3. Facebook News Feed Eradicator

  4. SelfControl App for Mac


Just because a substance has exceptionally low risk of acute harm doesn’t mean that you won’t learn useful things from a small amount of research!

For smoked cannabis, read: this guide. If you get anxiety when smoking, this list of supplements for reducing anxiety is meant for classic psychedelics but should apply to cannabis also.

For edibles, read: edibles guide by TripSafe and this guide.

Generally, read this.


New to RollSafe.org or MDMA? Start here.

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Recommended documentary about MDMA therapy: Trip of Compassion.